This week's announcement (July 20, 2016 - Canadian Healthcare Technology) that Nightingale Informatix Corp. has entered into a definitive agreement to sell its Canadian assets to Telus Health for a purchase price of $14 million is another indication that the Canadian EMR market is further consolidating.

As the largest EMR company in Canada, Telus Health now has a number of EMR products in its suite of offerings. Each continues to function as a distinct entity under the Telus umbrella and although there have been rumblings of a single universal EMR offering being provided by Telus, this is yet to occur.

While some products may be evidently superior to others and it is expected that there will be an eventual migration to specific products, even within a single company such as Telus, it is highly likely that every product has their own group of highly satisfied users. At CanadianEMR, we see this in the user ratings.

There is a lesson we can learn from countries such as Denmark when it comes to consolidation.

A number of years ago, I talked with one of the lead physicians in the Danish Health IT program about the status of their EMR industry. Denmark is a fully saturated market. In addition, the products available are all able to provide the core functionality that is needed to operate in the Danish healthcare system. As a result there is very little incentive for physicians to migrate from one product to another, even if there is a superior product. The practices have become used to their EMRs and change is extremely disruptive. More important, specific workflows or tweaks to their individual systems have been made over periods of years, leading to some level of customization in each practice. In many cases, their small tweaks have become critical to that specific practice's functioning.

As a result, even in a small market such as Denmark, following consolidation, some vendors continued to manage and support 3 or more EMR products.

However, the difference to Canada is that all of their EMR products are fully inter-operable in that they are able to send and receive messages from one another and national systems. This interoperability is the key.

While it may not be financially viable for a company even the size of Telus Health to support large numbers of EMR products, that is a business decision that will be need to be made.

From a functionality perspective, if we can achieve messaging interoperability between the different EMR systems, in my opinion, that is the most important step we can take towards ensuring seamless care for Canadians.

In 2008, I sat as co-chair on the Canada Health Infoway Clinical Subcommittee (CSC) on standards. At that time, an important part of my agenda was to move forward messaging standards for EMR to EMR interoperability. In fact, it was due to the lack of commitment by Infoway in pursuing this goal that I finally resigned as co-chair and quit the committee. I was informed that EMR standards were #51 on the priority list of Canada Health Infoway's standard collaborative. See National Post article - Avoid the Boondoggle. Top 10 would have been worth fighting for, but #51 was too big a hill to climb at that time.

How this has come back to bite us all. Now that EMRs are well adopted by the majority of physicians across Canada, we have yet to achieve ubiquitous secure messaging capability between EMR systems. It is extremely difficult to reverse engineer this capability into EMR systems, not just to ensure the information is able to flow smoothly and dependably, but with semantic interoperability. In other words, the ability to ensure that information in one system, once transmitted, has the same meaningin the receiving system.

An announcement today in Technology for Doctors, QHR, Telus set to create national messaging standards is a welcome step in this direction. However, it is important to note that it has taken the EMR vendors themselves to move this agenda forwards, while at the same time inviting other EMR vendors to participate in the process. It is my hope that this truly represents the next critical step towards a more seamless and connected system for transfer of patient information between physicians and other care providers, particularly as shared care becomes more prevalent in private practice settings.

The top-down approach may have moved the acute care system and hospitals in the right direction, however they are still not without their difficulties. However, it boggles my mind that we could have missed the importance of EMR-to-EMR seamless interoperability. Particularly because the large majority of care in this country is provided by family physicians and specialists in private practice settings.

I anticipate a rising groundswell of physician dissatisfaction with the Status Quo. There is no reason in 2016 that we should still be functioning in practice or product specific data silos.

I hope we get it right this time. After an expenditure of multi-billions of dollars, we should be further along that we currently are.

So, how do we do it differently going forward? What are the key foundational requirements for success and what can we avoid repeating so that in 2025 we are not debating and arguing about the same issues?

A number of years ago I began to work in addictions, an area of practice that I now find extremely satisfying despite all of its inherent challenges. In comparison to family practice, with a practice roster of over 1,500 patients, I now look after less than 100 patients. Many of these have a high level of acuity as well as concurrent mental health issues and comorbid diseases such as HIV and Hepatitis C. While many patients struggle with their substance use issues on a daily basis, a significant number are stable and some have been in recovery for years. They are also very grateful for their recovery and continue to depend on their physicians, sponsors, support groups and counsellors to maintain their sobriety.

Patients with addiction issues have some unique challenges that make them very good candidates for remote care or telehealth. They may have to travel large distances to attend clinic appointments which is complicated by a need to depend on public transit. They frequently have financial issues as a result of their addictions, resulting in great difficulty if they need to purchase transit tickets. In addition, if working, they may be in remote locations, creating added difficulty in attending appointments consistently.

While telehealth is not appropriate for the majority of patients with addiction disorders, there is a specific patient population in which it is not only appropriate, but preferable to use telehealth services to provide care for these individuals. Telehealth is not a replacement for face-to-face care. It is an adjunctive tool that can be used very effectively to maintain continuity of care in situations in which it is difficult to see patients face-to-face.

In addiction treatment, developing a therapeutic alliance with a patient is a critical part of their recovery. Many of these individuals are victims of physical, mental or sexual abuse. They have been abandoned by friends and families and lack any structured support systems. It takes time to develop a therapeutic alliance upon which patients can depend, particularly when making difficult changes to behavior that are uncomfortable mentally as well as physically. Addiction patients are not good candidates for walk-in type care. They need this continuity in order to maintain their progress as well as their long-term sobriety.

Because mental health is so strongly associated with substance use, telehealth is an effective medium in order to support their care at a distance. Video conferencing allows the physician or counsellor to assess a patient in a way that cannot be done using the telephone. There are subtle body language cues that can be missed if one tries to depend purely on telephone support.

Our addiction medicine practice is fully EMR enabled. While this does not preclude other addiction practices from using telehealth to provide remote care to a subset of patients, it is certainly easier when one has computers in every room with videoconferencing capability.

One also needs a platform to provide teleconsultation services. I personally looked into a number of services, each of which has pros and cons. Polycom is an advanced teleconferencing system that is widely used in healthcare and within the provincial regional healthcare facilities, so using a Polycom system may make sense if you plan to provide teleconsultation services to patients in regional settings. After an extensive review I selected Medeo as my primary teleconhealth platform. Medeo provides a waiting room for patients, scheduling service, secure messaging and the ability to use desktops as well as mobile devices such as telephones or iPads. It is my opinion that Medeo is one of the leading telehealth platforms in Canada and one that could very effectively meet the needs of physicians who provide remote care to their patients.

Based upon my use of the platform, CanadianEMR will be promoting Medeo as a telehealth platform in 2015 for Canadian physicians.

This is a fun, no-cost privacy awareness event that starts October 14. Participants receive a daily privacy challenge to help them review their existing policies, create new polices, and improve privacy and security best practices. The challenges require ‘entry-level’ skills and are applicable to both office and personal use.

Each day, for fifteen days, participants receive an e-mail with a privacy challenge. The task is a privacy or security best practice that can be used in home or business. Each email includes a short description about why this is a good practice, how to start it, and links to additional resources. Each challenge will take about 15 minutes to complete.

By Frida Cooper Aug 6, 2014 - Alright! So you have decided to be a medical transcriptionist. Congratulations! Great decision! Medical transcription is booming and these professionals are in demand everywhere, whether it’s a doctor’s office or a large healthcare setting. But now you’re saddled with the huge decision of choosing the right college, and that, my friend, is always a tricky affair!

Medical transcription is offered both as a traditional classroom course in a brick and mortar college or as an online program. Some colleges also offer programs in medical transcription editingwhere you review and edit documents generated by speech recognition software.If you’ve already started searching for colleges, you’re probably aware that online medical transcription training is much more in vogue. So stop looking around for answers because this article will tell you all about how you can get trained as a medical transcriptionist online!

Choosing the Right Medical Transcription Online Program

There’s no dearth of institutes offering onlinemedical transcription trainingcourses, but take time to evaluate your options and follow these suggestions to find the right institute.

The courses must cover the following subjects:

English language skills

Typing skills

Medical terminology

Pharmacology

Anatomy

Physiology

An overview of different types of medical records

Accreditation matters! Accredited schools and courses greatly enhance your employment prospects. It’s one of the few things an employer will look for when he reads your resume.

Is the course you choose preparing you for exams such as the Registered Healthcare Documentation by AHDI? Though this exam is voluntary, it is viewed as a stepping stone by professionals who wish to become Registered Medical Transcriptionists.

The online medical transcription training course should also provide sufficient hands-on practice with actual patient records and dictations by physicians. Listening to audio recordings will improve your hearing skills and show you what exactly medical transcription is all about!

Since you’re not attending a physical classroom session, it’s imperative that the institute provide you with everything that’s needed. Choose from a school, such as CIMT College, Elearn Canada College and CareerStep in Canada that offers not just textbooks and study material but online technical advice and support, a transcription foot pedal, a subscription to Benchmark KB, and a RHDS exam voucher!

The institute must assist with job placement. The placement assistance should cover tips on drafting the perfect resume and cover letter and prepare you for interviews. Some institutes also offer job assistance such as a help hotline for all its students for a full year after graduation!

Don’t hesitate to ask the institute for references from former students and organizations who have hired their students. You’re going to invest considerable time and money into this course and you need to be sure you’re getting bang for your buck!

Benefits of an online medical transcription course

An online course is designed to offer students a lot of flexibility. Anyone can do an online course, no matter where you live. You don’t have to bother with choosing a school that’s close to home!

You can customize online courses around your daily schedule and not vice versa. You study at your own pace and in your own time. So whether you’re a stay-at-home mom returning to work or someone wishing to switch to a new career, an online medical transcription program can be tailored to meet your demands!

Keep these tips in mind while looking for a program that fits your needs. You’re embarking upon a new career and it can be tough to decide upon what’s best for you from the sheer number of schools and courses at your disposal. Choose judiciously so you can look back upon your decision with pride and confidence and not have second thoughts!

About the Author: Frida Cooper has been working as a career guidance counselor for about 12 years. She’s stayed on top of growing industry trends through market research and interaction with young students and working professional alike. Her hobbies include swimming, meditation and music. She believes that everyone can enjoy a lucrative career by paying close attention to their passions and aptitudes.

In a letter to members sent out on March 12, 2014 by Doctors of BC (formally BCMA) President, Dr. William Cunningham confirmed that significant changes are about to take place with respect to the PITO funding program.

In summary:

The negotiated funds for the PITO program end on March 31, 2014. Attempts to negotiate further funds with government were unsuccessful and the PITO initiative is now considered complete and successful in reaching its objective of encouraging adoption of EMRs in community practices;

Approximately 5,000 physicians are now using EMRs in BC (90% of targeted physicians);

In order to assist physicians to reach a level of 'Meaningful Use' of their EMR systems, funding is being provided by the General Practice Services Committee and the Specialist Services Committee to support this optimization phase of EMR use for one additional year. Exact details of this funding are not yet available;

Ongoing monthly reimbursement of costs will no longer be paid beyond the conclusion of the contract - meaning that physicians will no longer receive funds to offset the cost of monthly vendor service fees (ranging from $200-$400 per month per physician).

Beyond the financial costs, Dr. Cunningham has recommended that physicians considering a transition from their ASP (remotely hosted) EMR systems to a local server version in order to reduce costs, think carefully about this change as only the secure ASP systems will be allowed to connect directly with provincial systems. This is particularly important in relation to new systems planned to start in the next 1-2 years.

The changes are dramatic, but not entirely unexpected. Physicians will begin feeling the bite of monthly EMR fees that were previously subsidized and will need to make adjustments to ensure that cash-flows are management optimally. Similar changes are expected in Alberta as the POSP program winds down at the conclusion of that province's provincial contract.

As more information becomes available on BC and Alberta, I will share through CanadianEMR.

Vancouver, B.C. – TELUS Health has acquired 100% of the shares of Med Access Inc., a leading Kelowna-based company providing electronic medical record (EMR) services to 2,000 specialty and general practice physicians in B.C., Alberta, Saskatchewan, Manitoba, and Ontario. The acquisition brings the total TELUS Health EMR reach to more than 12,500 Canadian physicians, supporting more than 45 million patient interactions each year. Financial terms are not being disclosed.

“EMRs are the cornerstone of emerging technologies, helping healthcare providers enhance patient care through better collaboration, cost management and workflow benefits. These technologies hold significant promise to reduce wait times and ultimately produce better health outcomes for Canadians,” said Paul Lepage, president, TELUS Health. “We believe that connecting healthcare providers and patients is a natural extension of our core business of connecting millions of Canadians with the people and information that matters most to them.”

TELUS Health plans to integrate Med Access’s industry-leading eReferral platform across all its EMR offerings, while continuing to support the Med Access EMR platform as one of the best EMR option available to Canadian physicians.

“The eReferral platform offers healthcare teams the opportunity to develop a new continuity of care strategy by allowing them to electronically forward any information in a patient’s chart directly to another care provider, thereby reducing potential data entry errors and helping to enhance patient care,” said Brendan Byrne, vice-president, TELUS physician solutions.

“We have every confidence that TELUS Health will be a great partner as we continue to develop our leading EMR platform to manage the complex demands of modern medicine and patient care,” said Paul Walker, president, Med Access. “They understand and support our vision to keep our customers’ interestsfront and centre at all times.”

Over the past six years, TELUS Health has invested more than $1 billion in healthcare technology development, including the acquisitions of EMR providers Wolf Medical Systems in Western Canada, PS Suite in Ontario and KinLogix in Quebec.

A practice in Chilliwack, British Columbia is using a patient health record system to share results, medication information and appointment results.

“Imagine having a patient who’s in Halifax experiencing a cardiac event; and the hospital there can access his latest EKG results from your office in BC. That kind of patient care really appeals to me and motivates me,” said Dr Cameron Ross, a GP at Crossroads Family Practice in Chilliwack. “That’s why, when Infoway gave a presentation about shared core datasets at the Family Medicine Forum in 2006, my first reaction was to think, ‘What a brilliant idea – where do I sign up?!’”

provides maternity and parental leave top-up payments to employees who are new mothers (to 75% of salary for 20 weeks) and offers a generous subsidy for in vitro fertilization (IVF) when needed (to $15,000)

In a related, but separate news item, Logibec Groupe Informatique Ltée (Logibec) announced December 9, 2013 that it has entered into a definitive agreement to acquire the Enterprise Management Solutions (“EMS”) division of QHR Technologies for a transaction price of CAD$20M, less working capital adjustments. The business unit will operate under the name of Quadrant upon closing of the transaction. All employees of the EMS division will be offered employment by Logibec. The transaction is expected to close in December 2013, subject to satisfaction of closing conditions. For more information on this announcement, click here.

It is now a couple of years since you have implemented your EMR. Your needs have evolved as you've become more proficient using the technology in your practice. In addition, your lease is up for renewal and you have important decisions to make. Do you renew your lease or move to a new practice location? Either may involve a refresh of the physical space with or without the financial support of your landlord. There are pros and cons either way, however staying in the same location and simply using the space more effectively reduces the needs for many of the administrative issues you may face. A major concern is disruption. How quickly can your office be refreshed? Is this turnkey or does the process continue piecemeal for days or weeks?

I had an opportunity recently to discuss these questions with a specialist in the office redesign market, Ruth Jankelowitz from the Janks Design Group.

AB: Ruth, as a design specialist, how do you respond to concerns about disruption to practice operations?

RJ: If you have a medical office that is tired or run down or are taking over an existing practice, scheduling and and tight timelines are critical. What we have done is develop a Five Day Makeover (FDM) that is best suited for renovations of existing offices/clinics. This renovation program incorporates weekend days resulting in only a 2 business day loss on the part of the clinic.

How does it work?

If planned well in advance, we recommend scheduling “On Call” duty for those days or maybe even a weekend away with the family;

We design and prepare all plans well ahead of implementation. We select all finishes, lighting, colours and ensure all ordering takes place well in advance to ensure every item is ready once we begin. In addition, detailed millwork plans are 100 % complete before raising a hammer;

Once everything is ready, the transformation begins...

A highly experienced construction team arrives on a late Thursday afternoon and removes all files and items to be stored/reused. The next step is to rip and strip (flooring, walls, furniture & lighting);

RJ: It is important that your design/implementation contractor understands your philosophy, demographics, tastes, target patient base and your budget. Our approach is to develop a conceptual design that best suits your needs and present it to you in 3D model so that you can virtually walk through the space and approve, before spending a penny on construction.

Once a conceptual design is in place, we prepare detailed permit & construction plans, handle permit process, issue detailed millwork and finishes plans for construction and assist through the entire construction process. Occasionally we also conduct tender processes and provide full project management services to some clients. Many of our clients, who are busy providing care to patients, want the project to be completely 'Turn Key' without any hassle or stress, so we manage the constraction as a project project.

AB: How can you be contacted if someone is interested in assistance or a quotation?